Term
What types of renal vascular diseases effect each of the following areas?
1) Vessel lumen
2) Vessel walls
3) Tubular epithelial cell
4) Interstitium |
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Definition
1) Thrombosis/Embolism
2) Vasculitis, HTN
3) Drugs, toxins
4) Inflammation and Infection |
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Term
What is the most common cause of renal failure in older adults?
What are the 2 major types? |
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Definition
HTN (diastolic BP >95)
1) Benign HTN (dBP 95-115)
2) Malignant HTN (Young AA males).
- Severe headache, retinopathy, acute and chronic renal failure (diastolic BP> 115) |
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Term
| What are the major causes of secondary HTN? |
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Definition
1) Renal
- Glomerulonephritis (chronic or acute)
- Arterial stenosis
2) Endocrine
- Adrenocortical hyperfunction (mineralcorticoids)
3) Vascular
- Atherosclerosis
- Vascular stenosis |
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Term
| How can you distinguish, pathologically, between benign and malignant Nephrosclerosis from HTN? |
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Definition
1) (Hyaline Arteriosclerosis)
Benign Nephrosclerosis will affect medium and small arteries, SPARING CAPILLARIES
- hyaline sclerosis, thickening and arterial fibroelastic intimal hyperplasia.
2) (Hyperplastic Arteriolsclerosis)
Malignant Nephrosclerosis affects ALL blood vessels
- arteriolar fibrinoid necrosis, capillary necrosis, "onion skinning" hyperplasia |
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Term
| What vasculitis is characterized by focal, segmental sclerosis and fibrosis of arcuate and intralobular arteries with P-ANCA antibodies? |
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Definition
Microscopic Polyangitis
1) PMN attack and infiltration of vessel walls
2) Healing of injured vessels leads to aneurysm formation and microinfarcts of kidney parenchyma (ischemia, sclerosis and fibrosis) |
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Term
| What vasculitis is characterized by granulomatous inflammation of blood vessels and destruction of Bowman's capsule? It has a C-ANCA association. |
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Definition
Wegener's Granulomatosis
- Histiocytes and giant cells attack vessel walls |
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Term
| What are the common Thrombotic diseases that affect the kidney? |
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Definition
Renal infarcts are clinically silent and wedge-shaped.
1) Disseminated intravascular coagulation (DIC)
- Septicemia complication
2) Thrombotic Thrombocytopenic Purpura (TTP)
3) Hemolytic Uremic Syndrome (HUS)
- Seen in E. coli poisoning, Breast cancer and oral contraceptives. |
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Term
| What kinds of tubulo-interstitial diseases arise and what do they all share? |
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Definition
All TIDs affect renal tubules and interstitium, but NOT glomeruli or vessels.
1) Ischemic
2) Infection
3) Toxin
4) Metabolic
5) Neoplasms
6) Immunologic |
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Term
| How can you distinguish, pathologically between ischemic and nephrotoxic causes of Acute Tubular Necrosis (ATN)? |
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Definition
Remember, ATN is REVERSIBLE with full recovery of renal function.
1) Ischemic will be focal and preceeded by hypotensive episode.
2) Nephrotoxic will be diffuse (mainly affecting metabolically active tubules) following ingestion of a toxin. |
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Term
What cell type should you look for to diagnose Tubulointerstitial Nephritis due to drugs?
What would you see on immunoflourescence (acutely) |
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Definition
Eosinophils against a backdrop of interstitial edema, since it is usually an allergic reaction.
On IF, you would see linear IgG and complement deposition along the tubular basement membrane.
Damage is proportional to the amount and duration of exposure! |
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Term
| What pathological findings are seen in the disease presents with the inability to concentrate urine and renal distal tubular acidosis, along with sterile pus in the urine in a patient who has taken aspirin for 4 years at 3-4 kg? |
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Definition
Chronic Analgesiic Nephritis
1) Absent renal papillae from necrosis
2) Normal sized kidneys with raised and depressed areas of atrophy over necrotic papillae
3) Cortical tubulointerstitial nephritis, necrosis and calcification. |
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Term
True or false:
Blood borne pathogens are the most dangerous forms of UTIs |
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Definition
True!
Ascending route is more common but less dangerous. Blood borne is more dangerous.
Remember, UTIs are found in young females (8:1) and produce acute Pyelonephritis and chronic Pyelonephritis over time (most commonly E. coli) |
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Term
| How does acute Pyelonephritis present microscopically? |
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Definition
1) Mostly PMNs in interstitium, eventually causing tubular damage.
2) Small microabscesses in the interstitium, which may become perinephric (painful) |
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Term
| How does Chronic Pyelonephritis present pathologically? |
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Definition
1) Broad scars in "geographic pattern" on calyces and renal pelvis.
2) Dense lymphocytic infiltrate and interstitial fibrosis present with focal segmental sclerosis and tubular atrophy. |
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Term
True or False:
Vasculitis is due to circulating auto-immune antibodies |
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Definition
True!
P-ANCA in Polyangiitis
C-ANCA in Wegner's |
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Term
| What differentiates acute and chronic drug-induced interstitial nephritis pathologically? |
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Definition
1) Acute is hypersensitivity (IgE and eosinophils)
2) Chronic is oxidative damage and can cause Transitional Cell Carcinoma (late complication) |
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Term
True or False:
UTIs most commonly involve patients' own bacteria |
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Definition
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Term
What should you think if you see each of the following cell types?
1) Eosinophils
2) PMNs
3) Lymphocytes
4) Giant cells
5) Histiocytes |
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Definition
1) Hypersensitivity (allergic) or Parasite
2) Acute bacterial
3) Chronic bacterial or viral
4) Fungal or Foreign body
5) Necrosis and clean up crew. |
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